The Assessment of Thromboembolism Risk in Postbariatric Patient: Our Experience in 936 Patients

open3openTanzillo, Giuseppe; Vindigni, Vincenzo; Bassetto, FrancoTanzillo, Giuseppe; Vindigni, Vincenzo; Bassetto, Franc

Immediate reaction to lidocaine with periorbital edema during upper blepharoplasty

Introduction: Blepharoplasty is the fourth most commonly performed cosmetic surgery in the US, with 207,000 operations in 2014. Lidocaine is the preferred anesthetic agent for blepharoplasty. Presentation of case: We describe the unusual case of acute periorbital edema following local anesthesia with lidocaine for upper blepharoplasty. At present, only two other reports of periorbital reactions to lidocaine are present in the literature. The reactions observed are significant palpebral swelling and erythema with scaling of the cheek. Fortunately the swelling, although marked, is transient in nature and resolves almost spontaneously without affecting the visual acuity. Discussion: Patients reporting adverse reactions should be screened for allergy according to the standard protocols, but skin testing has only been reported to be positive in less than 10% of all cases and allergy confirmation with IgE is even more rare. Conclusion: In clinical practice, we recommend that patient should be informed about the possibility of recurrence of an adverse reaction in case of re-exposure to lidocaine, even in the vast majority of cases where true allergy could not be proven. In case of further need for local anesthesia with history of an adverse event, a different agent may be chosen even from the same class (another amide) as cross-reactions in the amide group are rare. Otherwise, an anesthetic from the ester group can also be safely used

Dislocation of a cerebral protection device component during carotid stenting: A case report of favorable outcome from conservative management after failure of retrieval

tINTRODUCTION: Cerebral-protection devices (CPDs) are a well-established system for reduction ofembolic risk in carotid artery angioplasty and stenting (CAS). Although rare, adverse events with CPDsare unpredictable and can be associated with serious outcomes and iatrogenic sequelae.PRESENTATION OF CASE: We describe the unique case of dislocation of a FilterWire EXTMfilter loop duringright CAS. On trying to recapture the CPD filter at the end of the procedure, the filter loop suddenlydetached from the guidewire and dislocated to the proximal middle cerebral artery. Attempted retrievalof the loop failed and the patient developed a transient neurological deficit caused by an acute ischemicinfarction in the lenticular nucleus. No further retrieval attempt was pursued. No further dislocation ofthe loop or clinical event have been reported during the 16-year follow up.DISCUSSION: This case reported a favorable outcome of conservative management for entrapped materialfrom a CPD after iatrogenic damage from failed retrieval. No similar reports are available in the litera-ture, and conservative management is generally not a recommended approach because of the potentialcomplications. However, rescue retrieval attempts are as well a potential source of serious events, andno clear guidelines exist on the management of mechanical complications from CPD.CONCLUSION: Entrapment of CPD components constitutes an adverse event with no unique solution forrisk-free management. The potential risks associated with the use of protection devices are still to befully explored, and improving the standard of care and patient safety needs to be a top priority

Implementing clinical process management of vascular wounds in a tertiary facility: Impact evaluation of a performance improvement project

BACKGROUND: Chronic vascular wounds have a significant economic and social impact on our society calling for allocation of a great deal of attention and resources. Efforts should be oriented toward the achievement of the most effective and efficient clinical management. The Angiology Unit at the University Hospital of Padova, Italy, developed a performance improvement project to enhance the quality of practice for vascular ulcers. METHODS: The project consisted in a multistep process comprising a critical revision of the previous clinical process management, staff education, tightening connections between operators and services, and creation of a position for a wound care nurse. The previous standard of practice was modified according to the results of revision and the current evidence-based practice. RESULTS: The new standard of practice reached its full application in September 2015. The number of patients treated and the number of visits in 2015 remained almost unvaried from 2014. However, the total annual expenditure for treating vascular ulcers was reduced by ~60% from the previous year. CONCLUSION: Standardization of guidelines and practice is effective in creating an efficient clinical management and in reducing the economic burden of vascular ulcers

Behavioral and electrophysiological correlates of cognitive control in ex-obese adults

Impaired cognitive control functions have been documented in obesity. It remains unclear whether these functions normalize after weight reduction. We compared ex-obese individuals, who successfully underwent substantial weight loss after bariatric surgery, to normal weight participants on measures of resistance to interference, cognitive flexibility and response inhibition, obtained from the completion of two Stroop tasks, a Switching task and a Go/NoGo task, respectively. To elucidate the underlying brain mechanisms, event-related potentials (ERPs) in the latter two tasks were examined. As compared to controls, patients were more susceptible to the predominant but task-irrelevant stimulus dimension (i.e., they showed a larger verbal Stroop effect), and were slower in responding on trials requiring a task-set change rather than a task-set repetition (i.e., they showed a larger switch cost). The ERP correlates revealed altered anticipatory control mechanisms (switch positivity) and an exaggerated conflict monitoring response (N2). The results suggest that cognitive control is critical even in ex-obese individuals and should be monitored to promote weight loss maintenance

New Developments in Tissue Engineering of Microvascular Prostheses

none3noneV. VINDIGNI; ABATANGELO G; BASSETTO FVindigni, Vincenzo; Abatangelo, Giovanni; Bassetto, Franc

Nanotechnology-based therapies for skin wound regeneration

The cutting-edge combination of nanotechnology with medicine offers the unprecedented opportunity to create materials and devices at a nanoscale level, holding the potential to revolutionize currently available macroscale therapeutics. Nanotechnology already provides a plethora of advantages to medical care, and the success of nanoparticulate systems suggests that a progressive increase in the exploration of their potential will take place in the near future. An overview on the current applications of nanotechnology to wound healing and wound care is presented

Inguinocrural dermolipectomy A retrospective study

Inguinocrural dermolipectomy is a constantly increasing surgical procedure, especially for postbariatric patients with significant weight loss. The "crescent medial" and "vertical medial" thigh lifting techniques (CMTL/VMTL) are the most effective type of surgery to treat laxity and excess of skin and soft tissues in the medial region of the thighs Aim of this article is to suggest which patients may be eligible for a surgical thighplasty with an acceptable risk of postoperative complications

Comparison of Patient-reported Outcomes after Implant Versus Autologous Tissue Breast Reconstruction Using the BREAST-Q

Background: The demand for reconstructive breast procedures of various types has accelerated in recent years. Coupled with increased patient expectations, it has fostered the development of oncoplastic and reconstructive techniques in breast surgery. In the setting of postmastectomy reconstruction, patient satisfaction and quality of life are the most significant outcome variables when evaluating surgical success. The aim of this study was to evaluate the quality of life after implant breast reconstruction compared with autologous breast reconstruction. Materials and Methods: A cross-sectional study design was used. A total of 65 women who had completed postmastectomy implant-based or autologous reconstruction in the participating center were asked to complete the BREAST-Q (Reconstruction Module). Results: Data analysis demonstrated that women with autologous breast reconstruction were significantly more satisfied with their breasts (P = 0.0003) and with the overall outcome (P = 0.0001) compared with women with implant breast reconstruction. All other BREAST-Q parameters that were considered and observed were not significantly different between the 2 patient groups. Conclusions: Through statistical analysis, our results showed that patients who underwent autologous tissue reconstruction had better satisfaction with the reconstructed breast and the outcome, while both techniques appear to equally improve psychosocial well-being, sexual well-being, and chest satisfaction